P1700: EARLY APPEARANCE OF CARDIOTOXICITY, IN CHILDREN WITH HEMATOLOGICAL MALIGNANCIES (HM)
Authors: K. Antoniadi, C. Kelaidi, V. Tzotzola, M. Ampatzidou, E. Karanasios, M. Drakopoulou, V. Papadakis, P. Nihoyannopoulos, D. Tousoulis, K. Toutouzas, N. Thomaidis, S. Polychronopoulou
Journal: HemaSphere (2022)

Background: Cardiotoxicity is the most serious non-hematological toxicity of cancer treatment and is defined as acute(<1 month) and early onset(< 1year from the initiation of treatment). Aims: Aim of the study is the prospective analysis of the acute and early onset cardiotoxicity and outcome of patients with HM. Methods: Cardiotoxicity was defined by any combination of 1) reduction of the ejection fraction> 10% or at a value <50%) 2) electrophysiological dysfunction 3) other abnormal ultrasound, clinical or enzymatic findings. During the period 2018-2021, 47 patients with HM treated in our Department were studied, due to early cardiotoxicity. Patiens’ characteristics:30/47 boys, median age 8.0 years old (range 2.5-16), 25 with ALL, 7 with AML, 2 with CML and 13 with Lymphoma. All patients underwent a complete clinical, laboratory and imaging examination (ECG, echocardiogram) at diagnosis, prior each regimen and at the onset of signs of cardiotoxicity. Results: At admission 44/47 patients had a free medical history and normal tests. Two patients (1 with Hodgkin’s lymphoma and 1 with AML) had an abnormal troponin value before starting chemotherapy, without further clinical manifestations. The third patient, 3.5 years old with ALL, had hypertrophic cardiomyopathy from birth due to inherited Noonan syndrome. Thirteen patients (9/13 boys) showed cardiotoxicity, 2 after the first regimen of chemotherapy (acute form) and 11 within the 1st year after onset (subacute form). Acute cardiotoxicity occurred in two patients (1 with high-risk ALL, 1 with Burkitt Lymphoma) with a decrease in ejection fraction (EF <55%) along with bradycardia and abnormal ECG. Subacute form of cardiotoxicity occurred in 11/13 patients. 4 patients (1 with AML high-risk monosomy 7, 1 with Hodgkin’s Lymphoma, 1 with ALL and 1 with T-Lymphoblastic Lymphoma) showed reduced in ejection fraction (<55%) and concomitant increase in troponin value (max 35.85 pg/ml). Two patients with ALL showed an increase in cardiac enzymes (max value 98.05 pg / ml) with concomitant ECG disturbance and normal echocardiographic study. Two high-risk AML patients (1 due to FLT3 positivity), presented with pericardial fluid and QTc prolongation, respectively. One intermediate risk AML patient developed abnormal ventricular contractions with normal echocardiogram and cardiac enzymes and was treated with propranolol. Two patients, one with Hodgkin’ Lymphoma and one with Burkitt Lymphoma, developed chest pain with elevated troponin but with normal ECG and echocardiographic study. Forty five patients received anthracyclines in a total dose of anthracyclines <360mg / m2 and no-one was irradiated. All thirteen patients showed gradual recovery over a period of 1 week to 2 months after the event. 5 patients were treated with ACE inhibitor or b-blocker. All patients continued their chemotherapy in full doses (2/13 with minor delay). In one patient the total dose was reduced to 1/3. Summary/Conclusion: The early results of our ongoing study, show that moderate or severe cardiotoxicity occurred in 30% of patients with hematologic malignancies within the first year of diagnosis and 10% of them needed pharmaceutical intervention. The degree and course of cardiotoxicity seem to differ significantly between our patients, suggesting that both the underlying genetic predisposition and the presence of various other risk factors contribute to the severity of its manifestation.